Anna Giulia Cattaneo - DBSV - University of Insubria - Varese
According to WHO's estimate, 25% of elder people have cognitive
impairment or dementia, 4-6% of older persons have suffered
some form of maltreatment at home, and this trend seems to
increase in countries which experience rapid increase in aged
population. Since elder population is expected to increase
worldwide, special attention should be given to prevention
of abuse at home and institutional environments. The problem
is not limited to the individual level, but it involves the
community, and the strategies eventually developed to limit
the abuse must be taking into account social and cultural
aspects. The mistreatment is followed by increased incidence
of side effects of drugs, orthopaedic and emergency accidents,
development of sore pressure, rapid and progressive decline,
and enhanced frequency of mental conditions, such as depression
and suicidal thinking. Poorly recognized forms of abuse and
neglect include inappropriate prescription of hypnotic medicaments
and non-adherence to the therapy in those living at nursing
home or having professional caregivers, not reported abuse,
and self-neglect . This last could be especially insidious
and threatening, especially for seniors living alone. It was
found associated with very high rate of admission to the Emergency
Care and with enhanced mortality rate within one year. The
aspects of abuse, in all its forms, and of its prevention,
are very different in different regions of the world.
The industrialized countries display a number of law, organization
and facilities to face the problem, and however it still remains
living, as demonstrated by recent studies. The Chicago Health
and Aging Project, Illinois, USA, registered a prevalence
of recognized abuse in older people as high as 15. This
data was very similar to that obtained in a previous cohort
study in the New Heaven population, in which a prevalence
of 12 of abused was found among the older people. The
utilization rate at the Emergency Department was higher in
those at risk of abuse (2.1 vs 0.7%) and cognitive decline
was an important risk factor. The rate of self-neglect, from
subjects included in the same study, was about ten times higher,
and was charged with higher utilization of the Emergency Department,
higher mortality within 1 year and higher need of hospice
utilization. The self-neglect was 4 times more frequent in
black than in whites. The type of abuse more perceived was
the psychological one, in comparison with financial, physical
and sexual. While the childhood remained the age of life more
exposed to violence, people which was abused early in life
tended to suffer repeated violence at different ages, especially
in the elderly. In Milwaukee County, Wisconsin, USA, the profile
of elder at risk to became a victim of abuse was to be older
then 75 (64%), woman (64%) and white (62%). The aggressors
were more often adult children or spouses and the condition
was frequently reported by the medicine professional or relatives.
A true statistic concerning the dimensions of the phenomenon
in Canada seems to be completely lacking in the country, at
least until 2011, because of the institutional tendency to
forget or even cover the problem, in the UK the rate of abuse
is underreported by both the patients and the caregivers.
This is the only result retrieved in the PubMed for European
Countries, searching for "neglect" or "abuse"
or "mistreatment" in aging people.
The First National Prevalence Survey in Israel (2004-2005)
revealed a prevalence of abuse among people aged 65 yrs and
more reaching 18%. The violence was mainly verbal, followed
by financial exploitation. Data were evenly distributed among
Arab and Jews populations. Women were more prone to be victims,
and Arab women the most vulnerable. Partner with mental and
social ineptitude, or unemployed, adult children were the
most frequent types of perpetrators.
In Asia, a ten-year observational study, aimed to induce
the governments to better surveillance, reported the following
picture. Several countries, Hong Kong and Thailand among others,
adopted measures to encourage the taking care of elder by
younger relatives, and to discourage neglect or abuse. In
other, abuse on elder people is punishable by law, but in
several cases the low is only valuable for old women, being
a special comma of lows protecting the females. In Singapore
psychological or emotional, financial, physical, and sexual
abuse is prosecutable by law, but the PubMed does not report
published studies on the extent of the phenomenon. Protected
homes for older needing help existed in Philippines before
1999. In 1990-2004 the Philippine Plan of Action for Older
Persons included measures against abuse, neglect and marginalization,
and in 2009 interventions to involve seniors in the social
life of the country were planned by the government. The China
promotes measures to improve the quality of life of older
people. Social measures include involvement in productive
activities, insurances, social integration and independent
life style. Abuse and abandonment are also seriously considered
by penal law, however, the modalities for obtaining help are
poorly known by the patients and by their relatives or taking-care.
A recent study reported a prevalence of abuse as high as 36%
in a rural town of the Hubei province. Psychological mistreatment
is predominant (27%), and it is also the form of abuse more
perceived by those suffering from it. The India does not have
a legislation specifically aimed to the protection of the
elderly, but the level of attention is growing, also in the
Academic environment. The Maintenance and Welfare of Parents
and Senior Citizens, issued in India in 2007, was aimed to
encourage the support of the oldest by the younger family
members. Only five Indians states out of 28 have initiated
a full integration of the Act in the legislation, additional
11 have started but not completed the process. Other laws,
however, limits mistreatment against elder people. The abuse
and neglect against residents in hospices and nursing homes
fall under an ancient treaty, the Indian Contract Act, but
the families are often unaware of it.
In conclusion, the abuse and neglect of older people seems
to be an important criminal act seriously affecting the wellness
of the frail patient as well that of the society. It not only
reduces the self esteem of the society which tolerate and
even justify these behaviour, but also imposes to it expensive
interventions and treatments to repair to the damage. As the
population is aging, a coordinated, decisive and harmonious
intervention at social and cultural level seems to be unavoidable
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